2. GROUP MEMBERS
Preceptor: Pharm. Ibrahim A Kamal
Supervisors: Pharm. Othniel Masok
Pharm. Jordan Maichibi
Pharm. Rimfa Pontim
Members: Pharm. Eze Kingsley C
Pharm. Angela Ogbeche
Pharm. Arikpo Abam Onen
4. INTRODUCTION
Menopause is a natural process (usually).
The permanent cessation of menses for 12 consecutive
months (McKinley et al).
Occurs naturally (spontaneous) at a certain age.
Result of ovarian aging, decline in production of estrogen.
With decline in ovulation progesterone production also
declines.
Menstruation cessation due to non-iatrogenic (not medically
induced) ovarian failure before the age of 40 is referred to as
premature ovarian failure.
5. EPIDEMIOLOGY
The average age of physiologic menopause in the United
States is 52.
A research done by F.Olaolorun and T.Lawoyin in Ibadan
Nigeria put the average age for menopause at 50.2 years.
Furthermore a study conducted by Achie et al in
Kaduna's Zuturungu District on 135 subjects put the
average age for menopause at 44 years.
Factors such as smoking and malnutrition may affect the
onset menopause.
6. PHYSIOLOGY
The responsiveness of the ovaries to pituitary
gonadotropins such as follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) declines as they
age. Androstenedione levels drop by 50% around
menopause and estrone replaces estradiol as the
most common estrogen.
8. STAGES OF MENOPAUSE
Menopause transition lasts 4 to 8 years, but it lasts
longer in women who smoke. It is identified by
variations in the menstrual cycle length and is
classified into two stages: early and late. Because
hormones are fluctuating, this is usually the most
symptomatic phase.
The time interval after the last menstrual period is
referred to as post-menopause.
11. VAGINAL SYMPTOMS
As estrogen levels fall;
Vulvar and vaginal mucosae shrink,
Become drier, friable,
Lose suppleness.
The symptoms and signs of menopausal
genitourinary syndrome are caused by estrogen
and androgen deficiency.
12. Vasomotor symptoms endure 7.4 years on average
and up to ten years in certain women.
Hot flushes
Sweating
Chills at night
VASOMOTOR SYMPTOMS
13. Menopausal women lose bone density when their
estrogen levels decline, causing their bones to
become thin and brittle.
In addition, bladder muscles may become weakened
which could lead to urine leakage.
MUSCULOSKELETAL SYMPTOMS
14. DIAGNOSIS
Menopause is declared;
when a woman has not had menstrual periods
for 12 consecutive months.
FSH levels are greater than 3.0-11.0 mIU/mL.
pelvic examination with the presence of
vulvovaginal atrophy confirms the diagnosis.
15. GOALS OF THERAPY
To provide relief for vasomotor symptoms.
To prevent osteoporosis & other complications
of menopause.
Enhance productivity.
Improve quality of life.
To educate patients on the condition.
16. NON PHARMACOLOGICAL MANAGEMENT
Hot flushes may be relieved by the following:
Preventing triggers (e.g. spicy food, bright lights,
predictable emotional reactions).
Reducing alcohol and caffeine intake.
Vaginal atrophy can be relieved by:
Regular sexual contact or other vaginal
stimulation which help to maintain vaginal
function.
17.
18. Evening prime rose (Oenothera biennis) is a plant native to
Americans. The oil in its seeds contains Omega-6-fatty acids
such as gamma-linolenic acid (GLA).
Calcitriol is a vitamin D analogue given at 250ng twice daily,
with Calcium 500mg bd to prevent osteoporosis associated
with menopause.
Bisphosphonates such as alendronic acid is given as 10mg
once daily or 70mg once weekly for treatment of
osteoporosis or as 5mg daily for prophylaxis.
The only approved non-hormonal therapy for hot flushes is a
low dose (7.5 mg once daily) of paroxetine.
PHARMACOLOGICAL MANAGEMENT
19. Estradiol is taken orally at 1-2mg once daily for
vasomotor symptoms associated with menopause.
Post menopausal women with intact uterus (in
addition to estrogen treatment ) progestogen is
taken by mouth, 200mg at bed time for 12
consecutive days for the treatment of vulvovaginal
symptoms.
Ethinylestradiol given 10-20µg daily (with
progestogen if necessary)
HORMONAL REPLACEMENT
THERAPY
20. Women who are 60 years old or 10 years past
menopause onset may benefit from hormone
therapy if they are at risk of bone loss or fracture.
Conjugated estrogen / bazedoxifene protects the
uterus without the need for a progestogen.
HORMONAL REPLACEMENT THERAPY
21. A SAMPLED CASE REVIEW IN FMC KEFFI
EA is a 45 year old female trader, who had myomectomy
10 weeks earlier. Presented with purulent vaginal
discharge for about 5 days in GYNAE Clinic and was
placed on antibiotics after examination. She visited the
clinic after 7days complaining of horrible hot flushes
about four times a day and usually last for 15 minutes
when it comes. She had stopped the antibiotics five days
earlier thinking it was due to the drugs but the hot flushes
still persisted.
Provisional Diagnosis: Perimenopausal Symptoms
22. Evening primrose 1 cap daily for a month
Follow-up Visit:
Patient visited GYNAE Clinic after two weeks of
initiating primerose with the Perimenopausal
Symptoms reduced.
TREATMENT PLAN
23. PHARMACIST ROLE
1. Discussing options for managing symptoms and
long term health concerns with the patient.
2. Reviewing the risk and benefit associated with each
option.
3. Providing individualized patient education.
24. CONCLUSION
Menopause is a natural phenomenon brought about by
age , it could also occur as a result of certain iatrogenic
factors.
The average age for menopause in Nigeria is 50.2yrs.
Symptoms may worsen over time except for vulvovaginal
atrophy.
Hormone therapy is currently the mainstay in the
management of menopause
Potential harms are greater for women who start
hormone therapy after age 60.
25. REFERENCES
Faubion, S.S., Kingsberg, S.A., Clark, A.L., Kaunitz, A.M., Spadt, S.K., Larkin, L.C., Mitchell,
C.M., Shifren, J.L., Simon, J.A. and McClung, M.R., 2020. The 2020 genitourinary syndrome of
menopause position statement of The North American Menopause
Society. Menopause, 27(9), pp.976-992.
Faubion, S.S., Larkin, L.C., Stuenkel, C.A., Bachmann, G.A., Chism, L.A., Kagan, R., Kaunitz,
A.M., Krychman, M.L., Parish, S.J., Partridge, A.H. and Pinkerton, J.V., 2018. Management of
genitourinary syndrome of menopause in women with or at high risk for breast cancer:
consensus recommendations from The North American Menopause Society and The
International Society for the Study of Women's Sexual Health. Menopause, 25(6), pp.596-
608.
North American Menopause Society, 2017. The 2017 hormone therapy position statement
of the North American Menopause Society. Menopause, 24(7), pp.728-753.
Pinkerton, J.V., Pickar, J.H., Racketa, J. and Mirkin, S., 2012. Bazedoxifene/conjugated
estrogens for menopausal symptom treatment and osteoporosis
prevention. Climacteric, 15(5), pp.411-418.
Mckinlay, S.M, Brambilla,D.J. and Posner, J.G., 1992. The normal menopause transition.
Maturitas, 14(2),pp.103-115
